By now, the story of a Thai junior soccer team’s remarkable rescue has been heard around the world. On June 23, 12 boys and their coach were exploring a cave in Thailand when floodwaters from a monsoon blocked their access to exits and trapped them inside. Over two weeks later, rescue workers managed to get everyone safely above ground, with observers around the world celebrating a happy ending that initially seemed all but impossible.

While the boys’ safe return provided many reasons to rejoice, it is a mistake to assume that the soccer team’s harrowing ordeal is now over. Dr. Anka A. Vujanovic, associate professor of psychology and director of the UH Trauma and Stress Studies Center, and Dr. Emily LaVoy, assistant professor in the Department of Health and Human Performance, believe it is important for the boys and those around them to understand the physiological and mental consequences of trauma as they work toward full recovery.

“Being trapped in the darkness for weeks is undoubtedly a terrifying experience,” said Dr. Vujanovic. “The range of experiences during trauma can vary widely, from horror to hope to panic to dissociation. While we know that the severity of a trauma is associated with a greater risk of negative mental-health outcomes, the vast majority of people who experience trauma recover, and do not develop mental-health issues as a result. For the relative minority who develop psychological disturbances, the most common might be post-traumatic stress disorder, depression, or anxiety disorders, such as panic disorder or generalized anxiety disorder.”

Physical health also remains an ongoing concern for the soccer players, who spent many days in squalid conditions with limited access to food and potable water. Dr. LaVoy, who studies the impacts of trauma on immune health, stresses that the boys’ depleted white blood cell counts and altered Circadian rhythms pose continued risks.

“While in the cave, [the boys] faced malnutrition, a great deal of stress and anxiety, and disrupted Circadian rhythms,” said Dr. LaVoy. “The immune system, like many bodily systems, is influenced by Circadian rhythms. The physical and mental insults from being trapped leave the boys with suppressed immune systems and elevated risks of disease.”

According to Dr. Vujanovic, traumatic experiences do not always lead to negative long-term effects, but trauma still plays a key role in shaping one’s mental health.

“In the immediate aftermath of a traumatic event, it is expected that most people might experience short-term distress and acute changes in mood, thought patterns, sleep-wake cycles, or appetite. However, to assist with trauma recovery, families can let survivors know that they are there to support them in whatever way would be helpful. It is important that family members do not try to avoid discussing the trauma, as that can inadvertently send messages that the trauma is too big, too intense, or too frightening to be remembered or discussed,” said Dr. Vujanovic.

Although many challenges still lie ahead, Dr. LaVoy believes there is reason to be optimistic about the boys’ immune health. “They are being watched for infections, because of their suppressed immunity and the chance that they encountered rare pathogens from creatures, like bats, living in the cave,” said Dr. LaVoy. “Luckily, their youth—and the fact that they were physically active soccer players—makes them likely to be more resilient.”